Last year saw yet more cases of the theft of valuables and possessions from service users in the care sector, many of the crimes perpetrated by the very staff paid to protect them. Martin Hodgson investigates the situation.
In September 2011, in a typical case, a care worker from a home in Oldham was jailed after being found guilty of stealing gold rings and jewellery from vulnerable residents, including one aged 101. The mother of two targeted three pensioners at the home — including two who suffered from dementia — because she was short of money at Christmas. She was discovered after an inventory of jewellery was checked.
The Care Quality Commission (CQC) has announced that it will target home care services during 2012. The programme will help the regulator develop new ways to ensure these services meet the standards people have a right to expect and that service users are being treated with the appropriate dignity and respect.
The programme will start in April and will cover about 250 providers of domiciliary care services. It will run alongside CQC’s planned reviews and focus on three outcomes:
Respecting and involving people who use services
Care and welfare of people who use services
The programme will be supported by an advisory group, with members drawn from a range of organisations including the Equality and Human Rights Commission, Age UK, the United Kingdom Homecare Association and the Association of Directors of Adult Social Services.
These inspections follow concerns about incidents of theft by staff from the homes of service users and a lack of respect for their property and dignity. These concerns have been made graphically in a new report by the Equality and Human Rights Commission.
What are these concerns and what can home care managers do to ensure they have the right policies and procedures in place to combat theft of property?
Property thefts by staff in the home care sector
The highest standards of probity and honesty are required from care home staff at all times and care home managers should never compromise these standards or accept anything less. Staff in a care home setting will generally have considerable access to the personal possessions of many of their service users and will work unobserved for long periods behind the closed doors of service users' homes. It is therefore vital that they can be trusted to have complete respect for both their service users and their property.
Theft from a service user by a member of staff who is in a position of trust and has a duty to protect is a serious form of criminal abuse and should be treated as such. Home care organisations should have robust policies about abuse of all types and these policies should be well known to staff and carefully articulated to them. At induction all new staff should be taught about abuse and about the standards of honesty they will be expected to meet. Safeguarding training should then be a feature of ongoing training programmes for all staff.
All cases of suspected theft should be properly investigated and, where necessary, reported to the police and the appropriate disciplinary action taken.
The Equality and Human Rights Commission report
The Commission's inquiry into home care in England, published in November 2011, reveals disturbing evidence that the poor treatment of many older people is breaching their human rights. Around half of the older people, friends and family members who gave evidence to the inquiry expressed real satisfaction with their home care. However, the inquiry also revealed many examples of older people’s human rights being breached, including theft and a lack of respect for service users' property and dignity.
The inquiry called on the Government, the CQC and local authorities to work together better to build human rights into home care and make sure that abuses are detected faster and dealt with more effectively.
Quite aside from the criminal aspects of thefts, the Care Quality Commission, with which all care organisations must be registered, includes issues of safeguarding service users from financial abuse as part of its compliance requirements.
Guidance about Compliance: Essential Standards of Quality and Safety, published in March 2010, contains the outcomes that the CQC expects service users to experience if a provider is compliant with the regulations. Within this guidance providers of adult social care services must comply with the requirements of Outcome 7: Safeguarding People who use Services from Abuse, principally concerned with protecting service users from all manner of personal threats, including financial abuse and theft.
In addition, Outcome 12: Requirements Relating to Workers states that providers must ensure that they protect service users against the risks of being looked after by inappropriate, unsuitable or unsafe staff by having effective recruitment and selection procedures in place, including measures such as Criminal Records Bureau (CRB) checks and vetting and barring procedures.
All care services must comply with these outcomes.
Amid rising concerns about a lack of respect and dignity for service users, the CQC has announced that it will target home care services in a “themed inspection” during 2012. Announcing the themed inspections the CQC Chief Executive, Cynthia Bower, said: “Home care is one of the most difficult areas of care to monitor. Often the people who use home care services find themselves in vulnerable circumstances and the operation of home care is not as transparent as care in hospitals and other sectors because the interactions happen behind closed doors in people’s homes. That is why we want to focus on this sector of social care in this way."
Property thefts from service users
Domiciliary care managers must be proactive and implement a zero-tolerance policy towards property thefts from service users by staff. At the same time training programmes must stress the need for core values such as dignity and respect for service users to be demonstrated at all times. Most property thefts are of small, high-value items such as jewellery. However, other items have been stolen in the past and, in addition, consumption of the service user's food or beverages, or inappropriate use of the service user's telephone, may also be regarded as theft.
In a care setting there are often many reasons put forward to explain the disappearance of personal possessions and money from service users. Some service users may be confused, depressed or have mental health issues that make them unreliable in keeping track of their possessions. They may talk about possessions they owned in the past that have long since disappeared.
Another way that some thefts are explained, especially of small items such as jewellery, is that they were given to the care worker as a gift.
Managers should never allow reports or rumours of thefts and disappearances to be disregarded for such reasons. Each case should be investigated properly, especially those involving elderly service users who may be confused as these may precisely be the type of vulnerable people targeted by thieves.
Allowing gifts to be accepted can lead to accusations of coercion, exploitation and fraud. All organisations are therefore advised to have a strict policy which outlaws the acceptance of gifts or cash.
In order to decrease the incidence of theft:
a zero tolerance approach to theft and fraud should be taken and every incident or suspicion should be investigated
staff should be trained to respect the property and dignity of service users at all times
recruitment procedures should consider very carefully the background of anyone whose work will bring them into contact with service users and should include appropriate CRB checks
staff training at all levels should deal with abuse and safeguarding
staff working with service users should be supervised carefully
any suspicion, evidence or reports of abuse should be followed up promptly
staff should be encouraged to watch for any evidence of theft and to report these immediately, if necessary “blowing the whistle” on others
policies and procedures relating to abuse should be widely publicised and kept up to date
property inventories should be kept where necessary and service users and relatives should be encouraged to report any unexplained disappearances of property.
Prevention strategies generally fall into three categories, those of "removing opportunity" for theft, increasing general security and ensuring only honest people have access to vulnerable service users.
Home care settings are unique in that the care worker is usually alone with the service user in their home for substantial parts of the working day. This means that usually there is little direct observation of the day-to-day behaviour of staff. Domiciliary care mangers must therefore ensure that effective systems of appraisal are in place and that staff are appropriately monitored and supervised. Where possible, feedback on performance should be obtained from service users and their relatives and any concerns addressed.
Service users need to feel that they and that their possessions are safe and encouraging sensible and proportionate security measures is an important element in helping them live safely with dignity and respect. They should therefore be encouraged not to leave valuables lying around and to be more aware of their personal security.
All domiciliary care organisations are advised to have a strict policy which outlaws the acceptance of gifts or cash. Allowing gifts to be accepted can lead to accusations of coercion, exploitation and fraud. While it is beyond the remit of this article, domiciliary care managers should also ensure that robust policies and procedures are in place for the handling of service users' money, including the keeping of appropriate records and regular audit. Theft of property and money often go hand in hand.
It is an essential safeguarding measure that everyone working in a care service is trustworthy and reliable, and that anyone who might want to harm or take advantage of service users is prevented, as far as possible, from working with vulnerable adults. Managers should therefore make a series of checks before appointing anyone — employees, volunteers or trainees — to any position caring for service users.
Checks should include:
verifying the identity of applicants
checking an applicant's right to work in the UK
checking professional qualifications
performing criminal record checks
This is supported by Outcome 12: Requirements Relating to Workers of the CQC Essential Standards, which states that providers must ensure that they protect service users against the risks of being looked after by inappropriate, unsuitable or unsafe staff.
In addition to the above checks, managers should ensure that all staff are appropriately trained, monitored, appraised and supervised.
Responding to incidents of property theft
Most domiciliary care organisations quite rightly have policies which state that theft from service users will not be tolerated and will always be referred to the police.
Staff should be encouraged to report any thefts or suspicions of thefts to a manager or supervisor without delay. If there is any evidence or suspicion that theft has occurred or is likely to occur, the issue must be thoroughly investigated. Action taken must be recorded and reported, if necessary, to the CQC.
All action taken in response to allegations, evidence or investigations of theft must be carried out in accordance with the organisation's established policies and procedures. Where there is evidence of theft then the case should be reported to the police and the organisation should follow its agreed disciplinary procedures.
Care staff who are convicted of thieving from service users should be referred to the Independent Safeguarding Authority so that they can be barred from working with vulnerable adults again.
‘Whistleblowing" describes an action whereby an employee makes a public disclosure to a third party about some wrongdoing of the employer or of some other member of staff in an organisation, such as malpractice, fraud, negligence or abuse.
Staff can feel intimidated by abusers, especially if the abuser is a member of senior staff, and there is also often a pressure to "stick together" with colleagues. Many staff are therefore tempted to keep quiet and ignore abusive activities such as thefts from service users.
To ensure staff feel free to report incidents every organisation should have a whistleblowing policy. This should state that staff will be supported if they take the step of reporting abuse and that to keep quiet about an abusive situation may in itself constitute a disciplinary or even criminal act.
The CQC have set up a new confidential whistleblowing helpline on 03000 61 61 61.
Last reviewed 16 February 2012